You're a lot more likely to find high school and middle school students using electronic cigarettes or even hookahs than traditional cigarettes, according to a new CDC report. Among high schoolers, cigarette use dived from more than 13% to 9.2% in 2014, but the use of e-cigarettes tripled from 4.5% to over 13% the same year, having already tripled from 1.5% in 2011, reports the Los Angeles Times. Hookah use nearly doubled to 9.4%, knocking cigarettes into third place and worrying health experts who warn that using the water pipes, unlike some other alternatives, carries many of the same risks as smoking cigarettes.
Overall, 24.6% of high schoolers and 7.7% of middle school kids used some kind of tobacco product last year, the study found. CDC Director Tom Frieden calls the results "alarming" and warns that e-cigarette use is getting kids hooked on nicotine, the AP reports. "The idea that kids are better off using e-cigarettes is just the wrong way of thinking about it," he says, but others aren't so sure. "The CDC should be celebrating that we're seeing a decline in youth smoking," a professor at Boston University's School of Public Health tells the Times, adding that if e-cigarettes were a gateway to regular cigarettes, as some health advocates warn, teen smoking rates would be going up instead of down. (Earlier this year, California declared vaping a public health risk.)